Describes constipation in those 12 and older. Covers symptoms, including few bowel movements, straining, and passing hard stools. Discusses treatment, including diet and use of laxatives. Includes interactive tool to help you decide when to call a doctor.

Constipation, Age 12 and Older

Topic Overview

Constipation occurs when stools are difficult
to pass. Some people are overly concerned with the frequency of their bowel
movements, because they have been taught that a healthy person has a bowel
movement every day. This is not true. Most people pass stools anywhere from 3
times a day to 3 times a week. If your stools are soft and pass easily, you are
not constipated.

Constipation is present if you have 2 or fewer
bowel movements each week or you do not take laxatives
and have 2 or more of the following problems at least 25% of the time:

Straining

Feeling that you do not
completely empty your bowels

Hard stools, or stools that look like
pellets

A feeling of being blocked up

You can't pass
stools unless you put a finger in your rectum or use manual pressure to pass a
stool.

Constipation may occur with cramping and pain in the rectum
caused by the strain of trying to pass hard, dry stools. You may have some
bloating and nausea. You may also have small amounts of bright red blood on the
stool or on the toilet tissue, caused by bleeding
hemorrhoids or a slight tearing of the anus (anal fissure) as the stool is pushed through the
anus. This should stop when the constipation is
controlled.

Constipation can mean the slow movement of stool through the intestines or problems releasing a stool.

Slow transit constipation

Lack of fiber is a common cause of constipation. Other
causes include:

Outlet delay constipation

Constipation is sometimes
caused by poor muscle tone in the pelvic area (outlet delay). Excessive
straining, needing manual pressure on the vaginal wall, or feelings of
incomplete emptying may be a symptom of this type of constipation. Outlet delay
constipation is caused by:

Delaying bowel movements because of convenience issues or
because having a bowel movement causes pain.

Constipation is more common in people older than 65.
People in this age group are more likely to have poor dietary habits and
increased medicine use. Older adults also often have decreased muscular
activity of the intestinal tract, which increases the time it takes for stool
to move through the intestines. Physical problems, such as
arthritis, may make sitting on the toilet
uncomfortable or painful.

Women report problems with constipation more often
than men.

If a stool becomes lodged in the rectum (impacted), mucus
and fluid may leak out around the stool, sometimes leading to leakage of fecal
material (fecal incontinence). You may experience this as constipation
alternating with episodes of diarrhea.

Severe pain (8 to 10): The pain
is so bad that you can't stand it for more than a few hours, can't sleep, and
can't do anything else except focus on the pain.

Moderate pain (5 to 7): The pain is bad enough to disrupt your
normal activities and your sleep, but you can tolerate it for hours or days.
Moderate can also mean pain that comes and goes even if it's severe when it's
there.

Mild pain (1 to 4): You notice the pain,
but it is not bad enough to disrupt your sleep or activities.

Blood in the stool can come from
anywhere in the digestive tract, such as the stomach or intestines. Depending
on where the blood is coming from and how fast it is moving, it may be bright
red, reddish brown, or black like tar.

A little bit of bright red
blood on the stool or on the toilet paper is often caused by mild irritation of
the rectum. For example, this can happen if you have to strain hard to pass a
stool or if you have a hemorrhoid.

Certain medicines and foods can affect the color of stool. Diarrhea
medicines (such as Pepto-Bismol) and iron tablets can make the stool black.
Eating lots of beets may turn the stool red. Eating foods with black or dark
blue food coloring can turn the stool black.

If you take a medicine that affects the blood's ability to clot, such as aspirin, warfarin (Coumadin), enoxaparin (Lovenox), or clopidogrel (Plavix), it can cause some blood in your stools. If you take a blood thinner and have ongoing blood in your stools, call your doctor to discuss your symptoms.

Seek Care Today

Based on your answers, you may need care soon. The
problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms
and arrange for care.

If you cannot reach your doctor or you don't
have one, seek care today.

Many prescription and nonprescription medicines can cause
constipation. A few examples are:

Antacids.

Antidepressants.

Some
blood pressure medicines.

Cold medicines
(antihistamines).

Calcium and iron
supplements.

Narcotic pain medicines.

Constipation, Age 11 and Younger

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and
arrange for care.

If you cannot reach your doctor or you don't have
one, seek care in the next hour.

You do not need to call an
ambulance unless:

You cannot travel safely either by driving
yourself or by having someone else drive you.

You are in an area
where heavy traffic or other problems may slow you down.

Home Treatment

Constipation can be treated at
home.

First:

Try gentle exercise. Take a short walk each
day. Gradually increase your walking time until you are walking for at least 20
minutes.

Make sure you drink enough fluids. Most adults should try
to drink between 8 and 10 glasses of water or noncaffeinated beverages each
day. Avoid alcoholic beverages and caffeine, which can increase
dehydration. If you have heart failure or kidney
failure, talk to your doctor about what amount of fluid is right for
you.

Include fruits, vegetables, and fiber in your diet each day.
Have a bran muffin or bran cereal for breakfast, and try eating a piece of
fruit for a mid-afternoon snack.

Schedule time each day for a bowel
movement (after breakfast, for example). Establishing a daily routine may help.
Take your time. Do not be in a hurry.

Support your feet with a small step stool [about
6 in. (15 cm)] when you sit on
the toilet. This will help flex your hips and place your pelvis in a more
normal "squatting" position for having a bowel movement.

If you are still constipated:

Add some processed or synthetic fiber—such as
Citrucel, Metamucil, or Perdiem—to your diet each day.

Try a stool
softener, such as Colace, if your stools are very hard.

Try a
rectal glycerin suppository. Follow the directions on the label. Do not use
more often than recommended on the label.

You may at times need to try a laxative. If your teen has constipation problems, talk to your teen's doctor before trying laxatives.

Osmotic laxatives (such as Fleet Phospho-Soda, Milk of Magnesia, or Miralax) and nonabsorbable sugars (such as lactulose or sorbitol) hold fluids in the intestine. They also draw fluids into the intestine from other tissue and blood vessels. This extra fluid in the intestines makes the stool softer and easier to pass. Drink plenty of water when you use this type of laxative.

Stimulant
laxatives (such as Ex-Lax or Feen-a-Mint) speed up the movement of stool through the intestine. Use these
preparations sparingly. Overuse of stimulant laxatives decreases the tone and
sensation in the large intestine, causing dependence on using laxatives.
Regular use may interfere with your body's ability to absorb vitamin D and
calcium, which can weaken your bones. Do not use laxatives for longer than 2
weeks without consulting your doctor.

If you are
still constipated, check your symptoms to determine if and when
you need to see your doctor.

Talk to your doctor before using an
enema. Your doctor may need to check your symptoms or may suggest a different
way to treat your constipation.

If you have any of these symptoms, you need to be evaluated
by a doctor.

Prevention

You can prevent constipation.

Drink plenty of fluids, enough so that your urine is light yellow or clear like water.

Add high-fiber foods to your diet. Try to get 20 to 35 grams of fiber a day. Packaged foods and
fiber supplements include the amount of fiber content in the nutrition
information. You should increase the amount of fiber in your diet slowly so
that your stomach can adjust to the change. Adding too much fiber too quickly
may cause stomach upset and gas.

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How this information was developed to help you make better health decisions.